위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

조선후기 천문학자 이덕성의 생애와 천문활동

안영숙,민병희,서윤경,이기원,AHN, YOUNG SOOK,MIHN, BYEONG-HEE,SEO, YOON KYEONG,LEE, KI-WON 한국천문학회 2017 天文學論叢 Vol.32 No.2

The life and astronomical activity of Lee Deok-Seong (李德星, 1720-1794) was studied using various historical sources, including the astronomical almanac, Seungjeongwon-Ilgi (Daily records of Royal Secretariat of Joseon dynasty), and the Gwansang-Gam's logbooks during Joseon dynasty (A.D. 1392-1910). We present the results of the study including the following main findings. First, from the investigation of Lee's family tree, we find that a number of his relatives were also astronomers, notably Samryeok-Gwan (三曆官, the post of calendrical calculation). Second, we find that he took part in the compilation of an annual astronomical almanac over a period of at least 16 years. His major achievements in the astronomy of the Joseon dynasty were to establish a new method of calendar-making calculation and to bring astronomical materials to the Joseon court through a visit to China. The Joseon dynasty enforced the Shixianli (時憲曆, a Chinese calendar made by Adam Shall) in 1654 without fully understanding the calendar. So an astronomer and an envoy were dispatched to China in order to master the intricacies of the calendar and to learn as much of Western science as was available in that time and place. Lee Deok-Seong worked at the Gwansang-Gam (觀象監, Royal Astronomical Bureau) during the reigns of King Yeongjo (英祖) and Jeongjo (正祖). As best as we can ascertain in relation with the calculations in the Shixian calendar, Lee visited China four times. During his trips and interactions, he learned a new method for calendar-making calculations, and introduced many Western-Chinese astronomical books to Joseon academia. Lee greatly improved the accuracy of calendrical calculations, even while simplifying the calculation process. With these achievements, he finally was promoted to the title of Sungrok-Daebu (崇祿大夫), the third highest grade of royal official. In conclusion, history demonstrates that Lee Deok-Seong was one of the most outstanding astronomers in the late-Joseon dynasty.

시각장애학교 중등부 학생의 음악과 수업에 관한 인식

이경희,이해균 大邱大學校 師範大學 附設 敎育硏究所 2010 學校敎育硏究 Vol.6 No.1

이 연구의 목적은 시각장애학교 중등부 학생의 음악과 수업에 관한 인식을 연구하여 현행 시각장애 학교 중등부 학생의 효율적인 음악교육방안을 모색하고, 올바른 음악과 수업의 활성화를 위한 기초 자료를 제시하는데 있다. 이를 위해 전국 시각장애학교 중등부 학생 160명을 대상으로 성별, 학교급별, 시력 정도별, 시각장애 발생시기별 등의 배경 변인별로 음악과 수업에 관한 인식을 음악교육과정 5문항, 음악교사의 교육방법 8문항, 음악교육내용 11문항, 음악교육환경 5문항 등 총 29문항의 설문지로 구성하여 현장 조사하였다. 연구결과 음악과 교육과정에 대한 만족도는 후천성 시각장애학생이 선천성 시각장애학생보다 높게 나타났으며, 음악교사의 수업방법 중 점자악보 교육은 맹학생이 저시력학생보다 중학생이 고등학생보다 높게 나타났다. 음악과 수업에 대한 관심은 여학생이 남학생보다 높게 나타났으며 음악기자재 및 악기 활용은 저시력학생이 맹학생보다 높게 나타났다. 이와 같은 결과를 토대로 후속에 필요한 사항들을 제 언에 제시하였다. The object of this study was to survey the recognition of music classes in the secondary schools for the visually impaired students and find out efficient music method of present secondary schools for the visually impaired students, and to suggest basic materials with a view to activating right classes. Accordingly, The results, which are in the course of investigating and analyzing according to the respective variations of background and the respective factors, are as follows. First, in the areas of the recognition on the music class, the satisfaction on the music education curriculums, students with acquired visual impairments are higher than those with congenital visual impairments. In the area of the understanding on the braille musical note, blind students are higher than those with low vision and in the area of recognition on the braille or music note materials low vision students are higher than blind ones. Second, in the area of the recognition music teacher's education method, the variation of music class, low vision students are higher than blind students in the area of the effort of creativity female students are higher than male students. On the education of braille note, middle school students are higher and blind students are higher than low vision students. Third, in the area of the recognition of music class, interests on the music class, female students are higher than male students. On the understanding of the basic conception of music, female students are higher than male students, blind students are higher than low vision students, On the understanding of music class, female students are higher than male students, middle school students are higher than senior high school students, and blind students are higher than low vision students. On the satisfaction of music class, female students are higher than male students, students with acquired visually impaired are higher than students with congenitally visually impaired Fourth, in the area of the recognition of music education circumstances, on the level of musical materials and on the degree of the usage of musical instruments, low vision students are higher than blind students.

홍삼 조사포닌 성분의 중추작용

이순철,이수정,정경수,유관희,김학성 충남대학교 약학대학 의약품개발연구소 1995 藥學論文集 Vol.11 No.-

The present study was undertaken to elucidate the characteristics of red ginseng total saponin in behavioral changes on ambulation, forced swim test and convulsion in mice. The ambulation and the duration of immobility on forced swim test were not affected by red ginseng total sapinin. On the other hand, the duration of immobility induced by DMI, PGL but not CIP was significantly decreased, and the onset of convulsion induced by pentylenetetrazole was significantly shortened by preadminstration of red ginseng total saponin. These results suggest that red ginseng total saponin component may play an important role in modulation synergism with drugs acting on depression and convulsion, and that the characteristics of synergetic effect induced by red ginseng total saponin potentiate the central norepinephrine neuron activity.

실내공간에 도입된 꽃과 푸르름의 역할과 활용 : A Study on the Consumption Propensity and Behavior Pattern about Indoor Plants of the Apartment Inhabitants in Pusan 아파트 거주민의 실내식물에 대한 기호도 및 소비행태에 관하여

이영병,이경순,김진희 東亞大學校 大學院 1998 大學院論文集 Vol.23 No.-

This paper was to investigate interest and preference of the propensity to consume and consumption behavior pattern on indoor plants of inhabitants at the aparment in Pusan. The major summarized results of this research are as follows. People liked the roses the best and the most plant group was perennials according to the horticultural classification. The variety and color of plants were considered importantly on purchasing plants and the motive of purchasing plants was mainly for interior decoration, appreciation, and hobby. Most of people purchased plants at near-by retail flower shop. It was found that the indoor plants consumption was at a very olw level according as the yearly mean expense for purchasing plants was not sufficient and many people were more or less negative about the plant cost. They were passive to get expert knowledge and information and got them by magazine, neighbour, and television on indoor plants. A few people experienced a horticultural education at the culture center, chool, institution, and so on. They learned mostly flower arrangement but also wanted to learn a mini garden which were not satisfactory substance of the lecture. It was investigated that they thought indoor plants were positively related with their growth environment and the most important thing was good light. most people had some difficulties in maintaining indoor plants especially on reppoting, nutrient management, and disease control. They preferred floor type and shelf type arrangement and pot decoration types. In veranda was the place most indoor plnats were arranged place and people were very satisfied with their plants arranged. Also they spent time in maintaining and appreciating indoor plants usually between 8 and 12 o'clock. People felt that interior plants were not very popular because of limited space. People were very positive to effect of indoor plants was very psychological. using indoor plants in apartment, they could expect that, they could reduce the mental and physical stress, give a relaxation to themselves, and enhance interior decoration and individual hobby life and so on.

볼링후 발생한 전골간신경 증후군-증례 보고-

김혜경,이희숙,박준명,정광익,박동식 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.4

제대혈 채취 후 유로키나제의 첨가가 제대혈 적혈구 제거시 조혈모세포의 수득률에 미치는 영향

이영호,박현우,이영아,한훈,김경희,한진영 대한조혈모세포이식학회 2000 대한조혈모세포이식학회지 Vol.5 No.1

목적:제대혈 채취 후 24시간이 경과하여 적혈구를 제거하는 경우에 제대혈내의 응고계 및 섬유소 융해계의 변화로 인하여 clumping이나 미세혈전 등이 생겨 유핵세포나 CD34+ 세포의 수득률이 감소될 수 있다. 따라서 비록 항응고제가 처리된 제대혈이라 할지라도 제대혈 분리 전에 urokinase를 첨가하면 조혈모세포의 수득률을 높일 수 있을 것으로 생각된다. 그러나 현재까지 이에 대한 연구가 전혀 없는 상태이므로, 본 연구에서는 시간이 경과된 제대혈에 urokinase를 첨가하는 것이 효과가 있는지, 있다면 얼마의 용량이 적절한지 알아보기로 하였다. 방법:1) 채취한 후 48시간 경과된 제대혈에 대한 분석: 15례의 제대혈을 채취하여 채취 직후와 48시간 후에 10% pentastarch로 적혈구를 분리한 다음, 총유핵세포수와 CD34+ 세포수를 측정하여 수득률을 비교하였다. 48시간이 경과한 검체에 대하여 urokinase는 제대혈 분리 30분 전에 첨가하였으며, urokinase를 첨가하지 않은 군과 urokinase 5,000 IU/mL, 10,000 IU/mL, 50,000 IU/mL을 첨가한 네군으로 나누어 각각의 수득률을 비교 분석하였다. 2) 채취한 후 24시간이내의 제대혈에 대한 분석: 12례의 제대혈을 채취한 직후에 적혈구를 분리하여 총유핵세포수와 CD34+ 세포수, CFU-GM 집락수를 측정하였다. 동일한 검체를 6시간, 12시간, 24시간 동안 실온에 방치한 후 상기 실험 결과 가장 효과적인 용량의 urokinase를 첨가한 군과 첨가하지 않은 군으로 나누어 각각 적혈구를 분리한 다음, 총유핵세포수와 CD34+ 세포수, CFU-GM 집락수를 측정 비교하였다. 결과:1) 제대혈 채취 48시간 후에 urokinase를 첨가하지 않은 경우와 urokinase 5,000 IU/mL를 첨가한 경우 총유핵세포수의 차이가 없었지만, urokinase 10,000 IU/mL, 50,000 IU/mL를 첨가한 경우에는 urokinase를 첨가하지 않은 경우에 비하여 총유핵세포수의 의미있는 증가를 보였다(P=0.0024, P=0.0009). 2) 제대혈 채취 48시간 후에 urokinase 5,000 IU/mL이나 50,000 IU/mL를 첨가한 경우에는 urokinase를 첨가하지 않은 경우에 비하여 CD34+ 세포수의 차이가 없었지만, urokinase 10,000 IU/mL를 첨가한 경우에는 urokinase를 첨가하지 않은 경우에 비하여 CD34+ 세포수의 의미있는 증가를 보였다(P=0.0402). 3) Urokinase 10,000 IU/mL를 첨가하였던 군이나 첨가하지 않았던 군 모두에서 제대혈 채취 즉시 적혈구를 분리하였던 경우에 비하여 6시간, 12시간, 24시간이 경과할수록 총유핵세포수, CD34+ 세포수, CFU-GM 집락수가 약간씩 감소하였으나 시간경과에 따른 통계적 차이는 없었다. 또한 제대혈 채취 24시간 이내에는 각 시간대별로 urokinase 10,000 IU/mL 첨가 유무에 따른 총유핵세포수, CD34+ 세포수, CFU-GM 집락수의 통계적 차이를 나타내지 않았다. 결론:채혈한지 48시간 경과된 제대혈을 냉동 보관해야 하는 경우에는 urokinase 10,000 IU/mL를 첨가하고 30분 후에 적혈구를 분리하는 것이 유핵세포와 CD34+ 세포의 수득률을 높일 수 있는 방법이며, 24시간 이내에 적혈구를 분리하는 경우에는 urokinase를 첨가할 필요가 없을 것으로 생각된다. Background:We assessed whether the urokinase could increase the yield of progenitor cells during processing in elapsed, even anticoagulated, cord blood after collection, and also determined the optimal dosage of urokinase. Methods:Twenty-seven cord blood samples were collected with ACD-coated syringes from umbilical cord vein after full-term vaginal delivery, and red cells were depleted with 10% pentastarch. We assessed the effect and optimal dosage of urokinase by comparing total nucleated cell (TNC) counts and CD34+ cell counts between fresh and 48 hour-elapsed cord bloods. The urokinase was administered to the 48 hour-elapsed cord bloods 30 minutes before separation as the dose of 0 IU/mL, 5,000 IU/mL, 10,000 IU/mL and 50,000 IU/mL, respectively. Thereafter, by using the most effective dosage of urokinase, we also assessed the effect of urokinase in the 6, 12 and 24 hour-elapsed cord bloods. Results:The TNC counts after separation in 48 hour-elapsed cord bloods were significantly higher in 10,000 IU/mL and 50,000 IU/mL of urokinase treated samples than untreated and 5,000 IU/mL treated samples. The CD34+ cell counts were significantly higher in 10,000 IU/mL of urokinase treated samples than untreated and 5,000 or 50,000 IU/mL treated samples. In 6, 12 and 24 hour-elapsed cord bloods, however, there were no significant differences of TNC count, CD34+ cell count and CFU-GM count between 10,000 IU/mL of urokinase treated samples and untreated samples . Conclusion: The addition of 10,000 IU/mL of urokinase before separation of 48 hour-elapsed, even anticoagulated, cord bloods could increase the yield of progenitor cells. However, there are no advantage of urokinase for processing of cord bloods not elapsed 24 hours after collection.

장기입원환자 관리 방해요인

이경석,윤석만,권희,이호,김혜경,조미자,한규남,김명성 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Background: Recently the health insurance review agency tried to cut off the cost of unnecessary hospital stay. It is important to reduce the prolonged occupation of the hospital beds. However, there are some obstacles of the management for the prolonged bed occupation. We report our experiences and the problems of bed-control. Methods: To increase the rate of effective bed-usage, a task force was made. This team was consisted of 4 dctors, 2 nurses and 2 personnel of the administrative department. From December 20th 2001 to May 17th 2002, the task force analysed the rate, number and causes of the prolonged (more than 60 days, regardless of the disease entities) bed occupation. We announced and explained the necessity of bed-control and actively pressed to reduce the prolonged bed occupation. Results: The number of the prolonged bed occupation was 71 at the beginning of the management. It was reduced to 46 at best, then turned back to 65 at the end. It seems to be impossible to reduce the prolonged bed occupation until there are sufficient numbers of long-term care facilities. Aggressive bed control makes the sick patients to move every two or three months, it is never desirable. Conclusion: We cannot expect any Quality Improvements without improvement of the wrong system. Prior to the management for the prolonged bed occupation, it is necessary to build a sufficient number of long-term care facilities.

항 Vancomycin 내성균성 항생물질을 생산하는 Streptomyces sp.AMLK-335의 배양조건

이기형,임대석,최경희,이경호,김창한,김정환 건국대학교 동물자원연구센터 2000 動物資源硏究誌 Vol.21 No.-

본 연구는 새로운 항 vancomycin 내성균성 항생물질을 개발하기 위하여 실시되었으며, 전국 각지의 토양 시료로부터 분리한 방선균 중 vancomycin 내성균주인 K-98 Enterococcus faecium 642, K-98 Enterococcus faecium 637 균주에 대하여 항생물질을 생산하는 분리균주 AMLK-335를 선정하여 이 균주의 항생물질 생산에 대한 최적 발효 조건을 검토한 결과, 탄소원 첨가로는 glycerol(0.5%), 질소원 첨가로는 yeast extract(0.5%)가 가장 효과적으로 항생물질 생산에 이용되었고, 비타민을 첨가에 따른 항생물질 생산성의 차이는 크게 나타나지 않았으나, calcium pantothenate 첨가시 항균활성이 비교적 높아졌으며, 금속이온의 첨가는 K+, Pb+, Ba²+, NA²+ , Ca²+를 첨가하였을 때는 항생물질의 생산성이 비교적 높아졌으며, 그중 Ca²+ 첨가구가 가장 생산성이 높았으며, Fe²+ , Hg+의 금속이온을 첨가하였을 때는 항생물질 생산성이 감소하였으며, CaCO₃첨가는 비첨가구보다 높은 항생물질 생산성을 보였으나, 첨가량에 따른 영향은 대체적으로 없었다. pH의 변화에 따른 생산성은 전반적으로 pH가 항생 물질 생산에 영향을 미치지 못하였으나, pH 4.5∼6.0 부근에서는 비교적 높은 항생물질 생산성을보였으며, 통기량에 따른 항생물질 생산성은 통기량이 많을수록 항생물질 생산이 좋았다. 한편 배양기간에 따라 항생물질 생산성을 조사한 결과, 5일째에 가장 높은 항생물질 생산성을 나타내었으며, pH의 변화는 배양 초기에 하강하였다가 점차 상승하는 경향을 보였다. This study was carried out for examining antibiotic productivity of the strain Streptomyces sp. AMLK-335 producing anti-VRE antibiotic. According to different condition, the strain was cultured for 4 days at 27℃ and determined cell growth, pH value and antibiotic productivity using disk diffusion method. In the experiment, the strain Streptomyces sp. AMLK-335 was examined various culture conditions which was added 8 carbon sources, 12 nitrogen sources, 8 vitamins and 11 metal ions in each time and controlled concentration of CaCO₃, initial pH and aeration. From the studies of conditions for antibiotic production, antibiotic productivity was the best to use 0.5% glycerol as carbon source and 0.5% yeast extract as nitrogen source. When several vitamins were added to medium, there was little difference in antibiotic productivity. But the addition of calcium pantothenate slightly increased antimicrobial activity. The addition of metal ion, such as K+, Pb+, Ba²+, NA²+ and Ca²+ slightly increased antibiotic productivity except Fe²+ and Hg+. The addition of CaCo₃showed higher than non-addition experiment in antibiotic production, but there wasn't generally influenced at addition concentration. According to pH change, antibiotic productivity was increased at pH 4.5∼6.0, and when there was a lot of aeration, antibiotic productivity was increased.

우리나라 어린이와 청소년의 구강건강을 위한 공공서비스의 현황과 전망

이광희,김지영,송지현,김윤희,임경욱,정승열 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.3

소아치과학이 목표로 하는 어린이와 청소년의 구강건강을 달성하기 위하여는 민간 치과의료기관에서 내원 환자를 대상으로 하는 진료만으로는 한계가 있으며 공공서비스(公共service)의 역할이 필요하다. 학교구강보건설이 설치된 초등학교는 전체의 7.2%이었고,초등학교 중에서 불소용액양치사업을 수행한 비율은 57.5%, 급식 후 집단잇솔질을 한 비율은 46.9%이었으며,초등학생 중에서 구강보건교육을 받은 비율은 48.0%, 치아홈메우기를 받은 비율은 12.4%이었다(2006년). 0∼6세 영유아의 약 42%가 지난 1년간 구강검진,불소도포,치면세마,치아홈메우기 중 하나 이상의 예방적 치과진료를 받았으며,받은 장소는 교육시설이 약 18%, 보건소가 약 1%이었다(2005년). 불소농도가 조정된 수돗물을 마시는 인구 비율은 전국 평균이 5.7%이었다(2006년). 학교구강보건사업의 발전을 위해서 행정의 일원화,보건교사에 대한 교육,구강보건교사제도의 도입,순회 학교치과의사와 학교치과병원을 통한 포괄적 진료서비스의 제공 등을 고려할 수 있을 것이다. 또한 아동·청소년 주치의제의 도입으로 민간기관을 통해 공공서비스를 강화하는 방안이 검토되고 있다. To achieve the dental health of children and adolescents which is the objective of the pediatric dentistry, the role of the public service should be increased. The basis of the public service is established by many laws of which the Dental Health Law is most important. The percentages of primary schools that had the school dental health clinic, that implemented the fluoride rinsing program, and that implemented the group toothbrushing after lunch were 7.2%, 57.5%, and 46.9%, respectively, and the percentages of primary school children that received the dental health education and that received the fissure sealing were 48.0% and 12.4%, respective1y(2006). About 42% of infants and preschool children from 0 to 6 years received preventive dental care in the last one year, at the nursery or kindergarten(18%) or at the health center(1%)(2005). The percentage of the health centers that implemented water fluohdation was 11.3%, and the percentage of the population who drank the fluoridated water was 5.7 %(2006). It was suggested that the school dental health administration should be unified, that dental health teachers should be employed, and that the comprehensive dental health care should be supplied to all the children and adolescents through the circuit school dentists and the school dental hospitals in the long term. Also, the dentist in charge system for the children and adolescent was suggested.